COVID19 update, December 29, 2020: Belgium starts vaccination; over 500,000 vaccinated in Israel so far; China arrests author of Wuhan Diaries; asymptomatic transmission rare to nonexistent?

Very busy in day job and finishing a novella, so now that I finally have some time, here is a long update.

(1) De Standaard reports (in Dutch) that a 96-year old man named Jos Hermans yesterday morning was the first to get vaccinated there. I rang up one of my medical contacts there and was told that the supply of Pfizer vaccines is quite limited, and that they are having great hopes for the locally developed, single-shot, Janssen vaccine. Also that, should Janssen not be approved soon, that they are seriously considering giving just a single dose of Pfizer and Moderna, under the assumption that even that would be enough for 3 months protection, by which time there should not be further shortages.

(2) Meanwhile, Israel has now given first doses of Pfizer to over half a million people, the highest proportion of the population in the world (other than perhaps the city-state of Bahrain). From the JPost report:

Some 495,000 Israelis were vaccinated as of Tuesday morning, just nine days into the vaccination campaign, while 407,285 Israelis had been confirmed as infected with the virus since the beginning of the outbreak. More than 115,000 Israelis were vaccinated on Monday alone. A quarter of all 70- to 79-year-olds in Israel were vaccinated against the virus as of Tuesday morning, while 20% of Israelis in their 60’s, 18% of citizens in their 80’s and 11% of citizens 90-years-old and older were vaccinated as well. Some 1,765 Israelis under the age of 20 were vaccinated as well as of Tuesday morning, with 12 children under the age of 10 vaccinated despite regulations banning children under the age of 16 from receiving the vaccination.

And yes, this is completely voluntary — demand is overwhelming even without any mandate. The Times of Israel notes that teachers will be the next group to get access to the vaccine, following the 60+ age bracket and at-risk patients. It continues:

Provided Israel maintains this week’s pace of over 100,000 inoculations a day, it will see a dramatic easing of the pandemic crisis next month, said Eran Segal, a biologist at the Weizmann Institute of Science who has been mapping and analyzing the impact of COVID-19. “In two to three weeks, we’ll start to see a very significant fall in serious cases among the elderly and at-risk groups, and after that, of course, a reduction in fatalities.

Healthy people under 60, at present not eligible for the vaccine, account for just 7.5% of our mortality: according to this status page from the Clalit HMO. I am reproducing the most relevant table here:

Left=percentage of dead; middle=number of dead; right=age bracket; bottom row=totals

Don’t forget that the infection fatality rate is exponentially dependent on age, so In this manner, Israel will become the first major country-wide test case.

A nontrivial number of our friends and acquaintances (remember, those under 60 are not eligible at present) have so far gotten the jab. Many reported some fatigue on the first day, with some tenderness at the injection site persisting on the 2nd day (that was the case with Mrs. Arbel); others reported just some tenderness; yet others (such as our former department chair) no symptoms at all.

Major adverse events so far, out of half a million shots? One (1) man age 49, with a known allergy (to penicillin), went into anaphylactic shock but recovered following treatment (presumably with epinephrin) — I do wonder why he even got the shot at all. How often does this happen for “garden-variety” vaccinations? According to this 2016 paper in the Journal of Allergy and Clinical Immunology, https://doi.org/10.1016/j.jaci.2015.07.048

“We identified 33 confirmed vaccine-triggered anaphylaxis cases that occurred after 25,173,965 vaccine doses. The rate of anaphylaxis was 1.31 (95% CI, 0.90-1.84) per million vaccine doses. The incidence did not vary significantly by age, and there was a nonsignificant female predominance. Vaccine-specific rates included 1.35 (95% CI, 0.65-2.47) per million doses for inactivated trivalent influenza vaccine (10 cases, 7,434,628 doses given alone) and 1.83 (95% CI, 0.22-6.63) per million doses for inactivated monovalent influenza vaccine (2 cases, 1,090,279 doses given alone).

McNeil et al., “Risk of anaphylaxis after vaccination in children and adults”, J Allergy Clin Immunol. 2016 Mar; 137(3): 868–878.

In other words, one anaphylaxis per half-million patients is par for the course for vaccines.

In a separate incident, a 75-year old cardiac patient in Beit-Shean got a fatal heart attack 2 hours after the shot. He had waited half an hour at the clinic to rule out anaphylactic shock, then gone home. Initial investigation concluded that the event was unrelated to the vaccination, but a further investigation is in progress. Such fragile patients actually raise a medical conundrum: do you vaccinate them despite nonzero risk because their survival chances in case they catch COVID are slim — or do you precisely avoid stressing their labile systems with a vaccine?

I know a number of excitable people here have “discovered” that there were two dead among the 15,000 people who got Pfizer in the phase III clinical trial; what the said “discoverers” forget to mention are the four dead among the control group who were injected placebos. (Of course, nobody who understands statistics will claim that the placebo is twice as dangerous as the vaccine — those are the pitfalls of statistics of rare events. The most plausible explanation, of course, is that all six died natural deaths unrelated to either the vaccine or the placebo.)

Meanwhile, the homegrown Brilife vaccine (like Oxford/AstraZeneca a more conventional type) is in phase 2 trial; the developers from the Israel Institute for Biological Research are now worried that there won’t be enough healthy, unvaccinated people in Israel once they received approval for the phase 3 trial (which would require at least 15,000 people, preferably again that many as controls).

(3) There are times where I wonder if the US public health authorities would do a better job of alienating the public and engendering public distrust if they actively worked at it. After the forced retirement of Dr. Birx who exempted herself from her own social distancing recommendations, now we have Dr. Fauci basically justifying his own “telling lies in the service of a higher truth” (and yes, treating the American public like 5-year olds). Well, don’t be surprised then if you get outbursts like this in response to vaccination advice.

I am not going to pretend the Israeli public health authorities did everything perfectly. But by and large, they treated the public like adults and communicated on the level, without zig-zag course reversals for political expediency or in the name of political correctness.

(4) Miscellaneous:

  • In the PRC, CCP found nothing better than to slap a 4-year prison sentence on citizen journalist Zhang Zhan, who posted early reporting from Wuhan on YouTube. She has been force-fed while on a hunger strike during her pretrial arrest. The EU and the US have both called for her release. Wait for the CCP’s many turtle-boysuseful idiots in the Western media to whitewash this perversion of justice.
  • Jordan Schachtel is not impressed by the dubious evidence for “70% greater infectivity” of the new UK strain.
  • (Hat tip: multiple) A recently published meta-analysis of household transmission appears to indicate that asymptomatic transmission is quite rare if it exists at all: the “secondary attack rate” is 0.7%, but with the 95% confidence interval including zero. For comparison, the symptomatic rate is 18.0%, the 95% CI being 14.2%-22.1%
  • And (hat tip: Patrick R.) Pioneering computational biochemist (Nobel Laureate 2013) Mike Levitt resolves the conundrum of large(-sih) COVID19 mortality and much smaller “excess mortality” as follows: “now clear that COVID19 displaces Influenza due to viral competition for a limited pool [of] susceptible people. It has nothing to do with masks or hygiene as evidenced by winter flu in East Asia. Another piece of the puzzle falls into place.”

2 thoughts on “COVID19 update, December 29, 2020: Belgium starts vaccination; over 500,000 vaccinated in Israel so far; China arrests author of Wuhan Diaries; asymptomatic transmission rare to nonexistent?

  1. A comment – many people take the low rate of transmission from asymptomatic cases to mean that there is a low risk of transmission from people not showing symptoms.

    That is not the case – it results from confusion in terminology.

    An asymptomatic case is someone with COVID19 who never shows symptoms. But a significant amount of spread (~40%) comes from pre-symptomatic cases. That means people without symptoms are spreading it, but this is during a short period before they go on to develop symptoms. In other words, they are not asymptomatic *cases*, just spreading during an asymptomatic *period*.

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